More must be done on health care pricing

Jul 1, 2019

Jul 1, 2019

The Columbus Dispatch

Who hasn’t quibbled with the sales person when buying a new car or cell phone to get the best deal and some sense of knowing just what you’re paying for? When making any major purchase, smart consumers research options and compare pricing.

But in the health care marketplace, being a smart consumer is an elusive goal because all the cards aren’t on the table or easily discoverable. Buying medical care has long been a puzzle that defies understanding and resists attempts to subject it to transparency and control.

Nor will recent efforts at the state and federal level solve this puzzle anytime soon.

President Donald Trump’s executive order on Monday sounds like it could help, but it would be premature for this move to be cited in the president’s 2020 re-election campaign as a major accomplishment.

The president’s order calls for hospitals and health insurers to provide prices to patients in advance of undergoing many procedures, but it could take years for workable rules to be developed to put the executive order into practice.

Similarly, both the Ohio House of Representatives and the Ohio Senate included language in their versions of the $69 billion two-year state budget intended to increase transparency of prices for health care services in advance of scheduled procedures being performed.

Both the federal and state efforts also take aim at prohibiting surprise billing for services provided by physicians and others outside of a patient’s health insurance network, which can be especially expensive.

But questions remain as to how useful it would actually be to have increased health care price information available in the real world that patients must navigate.

Variables that complicate the system and pose obstacles to true consumer behavior in the health care marketplace include the very nature of patients’ need for medical attention — which can be sudden and unpredictable — as well as constraints created by their health insurance plans.

Consider an analogy to consumer behavior for buying a new refrigerator. One can shop online for the best price and read reviews to size up the quality of various brands and models available. About the only purchasing restriction a consumer may face is needing to be a member to buy the refrigerator from Sam’s Club or Costco.

But in the health care marketplace, there is no time to shop for emergency medical deals if you’re in a traffic accident or fall off a ladder while making home repairs. Even for planned procedures like a knee replacement or delivering a baby, getting a price estimate seven days in advance, as Ohio Senate language proposes, may not be soon enough to reschedule at a different hospital.

And then there is the question of which providers are in-network for your health insurance coverage.

Since health insurance became a standard employment benefit after World War II, Americans’ access to hospitals and doctors is largely a factor of their medical plan. And with hospitals increasingly acquiring previously independent physician practices, patients are steered by their doctors to specific hospitals for inpatient and outpatient procedures.

So it may be nice to know upfront the prices charged by hospitals and physicians and to know the co-pay or deductible demanded by your health plan, but few consumers will choose different providers if it means going out of network.

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